Access to medicines in remote and rural areas: a survey of residents in the Scottish Highlands & Western Isles.

OBJECTIVES: Sparsely populated areas are potentially predisposed to health inequalities due to limited access to services. This study aimed to explore and describe issues of access to medicines and related advice experienced by residents of the Scottish Highlands and Western Isles. STUDY DESIGN: Cross-sectional cohort study. METHODS: Anonymized questionnaires were mailed to a random sample of 6000 residents aged ≥18 years identified from the electoral register. The questionnaire contained items on: access to medicines; interactions with health care services; and perceptions of the services. Results were analysed using descriptive, inferential and spatial statistics. RESULTS: Adjusted response rate was 49.5% (2913/5889). Almost two thirds (63.4%, 1847) were prescribed medicines regularly, 88.5% (1634) of whom considered the source convenient. Pharmacy (73.8%, 1364) or dispensing GP (24.0%, 443) were the most accessed sources. Prescription medicine advice was mainly obtained from the GP (55.7%, 1029). Respondents ≥80 years old were significantly (P < 0.0001) more likely to live alone (45.3%, 92) compared with those <80 (15.8%, 424). Almost a fifth (16.5%, 31) of those >80 years living alone disagreed that they obtained prescribed medicines from a convenient source. The majority of respondents who felt they did not have a convenient medicines source, regardless of urban/rural classification, lived within five miles of a pharmacy or GP practice. CONCLUSIONS: Respondents accessed medicines and advice from a variety of sources. While most considered their access to medicines convenient, there were issues for those over 80 years and living alone. Perceived convenience would not appear to be solely based on geographical proximity to supply source. This requires further exploration given that these individuals are likely to have long-term conditions and be prescribed medicines on a chronic basis.

Association between severe disease course and nephritis with Q222R polymorphism in DNAse I gene among lupus patients: An Argentine multicenter study.

UNLABELLED: Objetives: Systemic lupus erythematosus is a multifactorial autoimmune disease and the glomerulonephritis is one of the most severe complications, which leads to severe persistent proteinuria, chronic renal failure, and end-stage renal disease. This multicenter study investigated the genetic associations of a non-synonymous single-nucleotide polymorphism in DNase I with the risk of lupus and its influence on development of nephropathy in an Argentinean population. METHODS: Using the Polymerase chain reaction restriction fragment length polymorphism method, the Q222R (+2373A→G; Gln244Arg) DNase I polymorphism was studied in 156 systemic lupus erythematosus patients and 170 healthy controls. RESULTS: Although no significant association between Q222R polymorphism and the risk of systemic lupus erythematosus was found, the presence of the A allele was associated with an increased risk for the development of nephropathy (p=0.019, Odd Ratio=2.196, 95 % confidence interval [1.135-4.247]) and a worse disease course [moderate disease course: p=0.006, Odd Ratio=3.250, 95% confidence interval (1.401-7.539); severe disease course: p=0.040, Odd Ratio=2.339, 95% confidence interval (1.040-5.260)]. CONCLUSIONS: A better understanding of the genetic basis of systemic lupus erythematosus will help in the development of new and more effectives strategies for the treatment of the disease in the future.

The effect of Anonchocephalus chilensis Riggenbach (Eucestoda: Bothriocephalidea) on infracommunity patterns in Genypterus maculatus Tschudi (Osteichthyes: Ophidiidae).

The use of parasite body size (i.e. body mass) is a promising proxy to improve the study of patterns in parasite infracommunities, which are usually analysed using only numerical descriptors. This study deals with the importance and effect of the presence of a large endoparasite species, the cestode Anonchocephalus chilensis in a marine fish species, Genypterus maculatus, on the structure of the parasite infracommunities. Numerical and volumetric measures of aggregated properties of parasite infracommunities were compared and their correlation examined. The highly dominant presence of A. chilensis by volume causes a dramatic change in the patterns observed, including a smaller total volume of the remaining species when this volumetrically dominant species is present. However, C-scores and V-ratios, both indices based on null models of species occurrence, do not support the idea of communities structured by interspecific competition. Analyses reveal that numerical and volumetric community descriptors are complementary ways to search for patterns and to reveal processes within these systems.